Turkish nurses' perspectives on a programme to reduce burnout

Barriers and facilitators to implementing workplace interventions to promote mental health: qualitative evidence synthesis

BACKGROUND

Despite growing interest in workplace mental health interventions, evidence of their effectiveness is mixed. Implementation science offers a valuable lens to investigate the factors influencing successful implementation. However, evidence synthesis is lacking, especially for small-to-medium-sized enterprises (SMEs) and for specific work sectors. The objectives of this review are to establish the scope of research with explicit analysis of implementation aspects of workplace mental health interventions and to identify barriers and facilitators to implementation in general and within SMEs and selected sectors.

METHODS

A systematic scoping review and meta-synthesis of mixed methods process evaluation research from 11 databases, with the evaluation of methodological quality (MMAT) and confidence in findings (CERQual), was conducted. We selected information-rich studies and synthesised them using domains within the Nielsen and Randall implementation framework: context, intervention activities, implementation; and mental models.

RESULTS

We included 43 studies published between 2009 and 2022, of which 22 were rated as information-rich to be analysed for barriers and facilitators. Most studies were conducted in healthcare. Facilitators reflecting 'high confidence' included: relevant and tailored content, continuous and pro-active leadership buy-in and support, internal or external change agents/champions, assistance from managers and peers, resources, and senior-level experience and awareness of mental health issues. Healthcare sector-specific facilitators included: easy accessibility with time provided, fostering relationships, clear communication, and perceptions of the intervention. Stigma and confidentiality issues were reported as barriers overall. Due to the small number of studies within SMEs reported findings did not reach 'high confidence'. A lack of studies in construction and Information and Communication Technology meant separate analyses were not possible.

CONCLUSIONS

There is dependable evidence of key factors for the implementation of workplace mental health interventions which should be used to improve implementation. However, there is a lack of studies in SMEs and in a larger variety of sectors.

SYSTEMATIC REVIEW REGISTRATION

Research Registry ( reviewregistry897 ).

"We're not broken. We're human." A qualitative meta-synthesis of health-care providers' experiences participating in well-being programs

INTRODUCTION

Protecting health-care provider (HCP) well-being is imperative to preserve health-care workforce capital, performance, and patient care quality. Limited evidence exists for the long-term effectiveness of HCP well-being programs, with less known about physiotherapists specifically.

PURPOSE

To review and synthesize qualitative research describing experiences of HCP, generate lessons learned from the greater population of HCP participating in workplace well-being programs, and then to inform programs and policies for optimizing psychological well-being in an understudied population of physiotherapists.

METHODS

This qualitative meta-synthesis included a systematic literature search conducted in September 2020; critical appraisal of results; and data reduction, re-categorizing, and thematic extraction (reciprocal translation) with interpretive triangulation.

RESULTS

Twenty-five papers met the inclusion criteria. Participants included physicians, nurses, and allied health providers. All programs targeted the individual provider and included psychoeducational offerings, supervision groups, coaching, and complementary therapies. Four themes were constructed: 1) beneficial outcomes across a range of programs; 2) facilitators of program success; 3) barriers to program success; and 4) unmet needs driving recommendations.

CONCLUSIONS

The findings enhance our understanding of diverse individual-level programs to address HCP well-being. Beneficial outcomes were achieved across program types with system-level support proving critical; however, HCP described barriers to program success (HCP characteristics, off-site programs, institutional culture) and remaining needs (resources, ethical dissonance) left unaddressed. Organizations should offer individual-level programs to support physiotherapists in the short term while pursuing long-term, system-level change to address drivers of well-being.

The effect of a nurse-led intervention program on compassion fatigue, burnout, compassion satisfaction, and psychological distress in nurses: A randomized controlled trial

PURPOSE

This study evaluated the effect of a nurse-led intervention program on compassion fatigue, burnout, compassion satisfaction, and psychological distress in nurses.

DESIGN AND METHODS

A randomized controlled trial was conducted. A total of 48 clinical nurses were randomly allocated to intervention or control groups. The nurse-led intervention program was based on a cognitive-behavioral approach. The study outcomes were compassion fatigue, burnout, compassion satisfaction, and psychological distress.

FINDINGS

It was determined that the psychological distress scores of the nurses participating in the program at the first follow-up were significantly lower than the control group. There was no significant difference between the groups in terms of compassion fatigue, burnout, and compassion satisfaction.

PRACTICAL IMPLICATIONS

To reduce the psychological distress of nurses, cognitive behavioral approach-based programs can be useful.

Oncology-Hematology Nurses' Perspectives on the Compassion Fatigue Resiliency Program: A Qualitative Study

Background Oncology-hematology nurses are at increased risk for compassion fatigue. It remains unclear whether the Compassion Fatigue Resiliency program is effective, and qualitative evidence from participant feedback is limited. This was a follow-up study to a quantitative study of the Compassion Fatigue Resiliency program. The aims of this study were to evaluate how the content of the program affects nurses' compassion fatigue and coping abilities and to obtain their views. Method This qualitative study was performed with 24 oncology-hematology nurses at two hospitals. Three focus groups were conducted using a semi-structured questionnaire. The data were analyzed using conventional content analysis. Results Four themes emerged: awareness; coping; not for others, for me; and training design. Nurses stated they had only just learned what compassion fatigue and its impact were and had gained more awareness. Conclusion The content of the Compassion Fatigue Resiliency program helped nurses learn effective coping skills; however, the program's design is important to its effectiveness. [J Contin Educ Nurs. 2022;53(7):329-336.].

Estresse e burnout em trabalhadores de enfermagem de Unidade de Cirurgia Geral

Objetivo: avaliar os níveis de estresse e burnout dos trabalhadores de enfermagem de clínica cirúrgica antes e após a participação em grupo de apoio. Materiais e método: estudo quase-experimental, realizado em um hospital público com 16 trabalhadores. Os dados foram coletados entre maio e junho de 2015, e no mesmo período em 2016, por meio de instrumento de características biossociaise laborais, da Escala de Estresse no Trabalho e do Inventário Maslach de Burnout. Resultados: antes da participação no grupo de apoio em 2015, houve predomínio de médio nível de estresse (50 %). Quanto ao burnout, evidenciaram-se níveis de baixo desgaste emocional (43,8 %), baixa despersonalização (56,3 %), baixa realização profissional (43,8 %) e nenhum caso de burnout. Em 2016, após a participação no grupo deapoio, o nível médio de estresse manteve-se prevalente (56,6 %). Para o burnout, houve aumento dos níveis de desgaste emocional e despersonalização, e diminuição da realização profissional. Apesar disso, também não foram identificados casos da síndrome. Conclusões: a participação no grupo de apoio mobilizou o aumento do alto nível de estresse, apesar da manutenção da prevalência de nível médio. Quanto ao burnout, notaram-se piora na avaliação do desgaste emocional, despersonalização e, consequentemente, diminuição da realização profissional. Situação que sinaliza atenção, pois mostra condição favorável para o surgimento de casos da síndrome. Contudo, ainda são necessárias intervenções com foco no enfrentamento dessesestressores ocupacionais.

Implementing practices focused on workplace health and psychological wellbeing: A systematic review

RATIONALE

Workplace health and wellbeing practices (WHWPs) often fail to improve psychological health or wellbeing because of implementation failure. Thus, implementation should be evaluated to improve the effectiveness of WHWPs.

OBJECTIVE

We conducted a systematic review to identify critical success factors for WHWP implementation and gaps in the evidence. Doing so provides a platform for future theoretical development.

METHODS

We reviewed 74 separate studies that assessed the implementation of WHWPs and their effects on psychological health or psychological wellbeing. Most studies were from advanced industrial Western democracies (71). Intervention types included primary (e.g., work redesign, 37 studies; and health behavior change, 8 studies), secondary (e.g., mindfulness training, 11 studies), tertiary (e.g., focused on rehabilitation, 9 studies), and multifocal (e.g., including components of primary and secondary, 9 studies).

RESULTS

Tangible changes preceded improvements in health and wellbeing, indicating intervention success cannot be attributed to non-specific factors. Some interventions had beneficial effects through mechanisms not planned as part of the intervention. Three factors were associated with successful WHWP implementation: continuation, learning, and effective governance.

CONCLUSIONS

The review indicates future research could focus on how organizations manage conflict between WHWP implementation and existing organizational processes, and the dynamic nature of organizational contexts that affect and are affected by WHWP implementation. This systematic review is registered [PROSPERO: the International Prospective Register of Systematic Reviews ID: CRD42019119656].

An examination of the correlation between nurses' organizational trust and burnout levels

INTRODUCTION

Decrease in the organizational trust level of nurses, leads to increase turnover rate of nurses, causes an increase in workload, causes a decrease in motivation and quality of patient care. The results caused by the lack of organizational trust is important for both individuals and organizations.

AIM

To investigate the relationship between nurses' organizational trust and burnout level.

METHOD

This descriptive and relational study is carried out at an university hospital with 155 nurses who were agreed to participate. Data were collected with Identifying Information Form, Organizational Trust Inventory and Maslach Burnout Inventory. Data were analyzed with numbers, percentage, mean standard deviation, spearman correlation analysis and multiple linear regression.

FINDINGS

A negative, very weak and statistically significant relationship was found between emotional exhaustion level and trust in employer level (r = 0.304, p < 0.01) and trust in institution level (r = 0.335, p < 0.01); a negative, very weak and statistically significant relationship was found between emotional exhaustion level and trust in colleagues level (r = 0.240, p < 0.01); between depersonalization level and trust in employer level (r = 0.315, p < 0.01); between depersonalization level and trust in colleagues level (r = 0.282, p < 0.01); between reduced personal accomplishment level and trust in employer level (r = 0.238, p < 0.01).

RESULTS

It was concluded that there was a statistically significant relationship between the nurses' organizational trust level and burnout level. In addition, organizational trust was a significant predictor of emotional exhaustion, depersonalization and reduced personal accomplishment level.

Nurses and stress: recognizing causes and seeking solutions

AIMS

To identify, from the perspectives of nurses, occupational stressors and ways in which they may be reduced.

BACKGROUND

Nurses commonly experience high levels of occupational stress, with negative consequences for their physical and psychological health, health-care organisations and community. There is minimal research on reducing occupational stress.

METHOD

Six focus groups were conducted with 38 registered nurses using a qualitative exploratory approach. Participants were asked to identify sources of occupational stress and possible workplace initiatives to reduce stress.

FINDINGS

Sources of occupational stress were: high workloads, unavailability of doctors, unsupportive management, human resource issues, interpersonal issues, patients' relatives, shift work, car parking, handover procedures, no common area for nurses, not progressing at work and patient mental health. Suggestions for reduction included: workload modification, non-ward-based initiatives, changing shift hours, forwarding suggestions for change, music, special events, organisational development, ensuring nurses get breaks, massage therapists, acknowledgement from management and leadership within wards.

CONCLUSION

The findings highlight the need to understand local perspectives and the importance of involving nurses in identifying initiatives to reduce occupational stress.

IMPLICATIONS FOR NURSING MANAGEMENT

Health-care environments can be enhanced through local understanding of the occupational stressors and productively engaging nurses in developing stress reduction initiatives. Nurse managers must facilitate such processes.

Understanding burnout according to individual differences: ongoing explanatory power evaluation of two models for measuring burnout types

Background

The classic determination of burnout is by means of the dimensions exhaustion, cynicism and inefficacy. A new definition of the syndrome is based on clinical subtypes, consisting of “frenetic” (involved, ambitious, overloaded), “underchallenged” (indifferent, bored, with lack of personal development) and “worn-out” (neglectful, unacknowledged, with little control). The dimensions of overload, lack of development and neglect form a shortened version of this perspective. The aims of this study were to estimate and to compare the explanatory power of both typological models, short and long, with the standard measurement.

Methods

This was a cross-sectional survey with a randomly sample of university employees (n=409). Multivariate linear regression models were constructed between the “Maslach Burnout Inventory General Survey” (MBI-GS) dimensions, as dependent variables, and the “Burnout Clinical Subtype Questionnaire” (BCSQ-36 and BCSQ-12) dimensions, as independent variables.

Results

The BCSQ-36 subscales together explained 53% of ‘exhaustion’ (p<0.001), 59% of ‘cynicism’ (p<0.001) and 37% of ‘efficacy’ (p<0.001), while BCSQ-12 subscales explained 44% of ‘exhaustion’ (p<0.001), 44% of ‘cynicism’ (p<0.001), and 30% of ‘efficacy’ (p<0.001). The difference in the explanatory power of both models was significant for ‘exhaustion’ (p<0.001), and for ‘cynicism’ (p<0.001) and ‘efficacy (p<0.001).

Conclusions

Both BCSQ-36 and BCSQ-12 demonstrate great explanatory power over the standard MBI-GS, while offering a useful characterization of the syndrome for the evaluation and design of interventions tailored to the characteristics of each individual. The BCSQ-36 may be very useful in mental health services, given that it provides a good deal of information, while the BCSQ-12 could be used as a screening measure in primary care consultations owing to its simplicity and functional nature.

Towards a brief definition of burnout syndrome by subtypes: development of the "Burnout Clinical Subtypes Questionnaire" (BCSQ-12)

Background

Burnout has traditionally been described by means of the dimensions of exhaustion, cynicism and lack of eficacy from the "Maslach Burnout Inventory-General Survey" (MBI-GS). The "Burnout Clinical Subtype Questionnaire" (BCSQ-12), comprising the dimensions of overload, lack of development and neglect, is proposed as a brief means of identifying the different ways this disorder is manifested. The aim of the study is to test the construct and criterial validity of the BCSQ-12.

Method

A cross-sectional design was used on a multi-occupational sample of randomly selected university employees (n = 826). An exploratory factor analysis (EFA) was performed on half of the sample using the maximum likelihood (ML) method with varimax orthogonal rotation, while confirmatory factor analysis (CFA) was performed on the other half by means of the ML method. ROC curve analysis was preformed in order to assess the discriminatory capacity of BCSQ-12 when compared to MBI-GS. Cut-off points were proposed for the BCSQ-12 that optimized sensitivity and specificity. Multivariate binary logistic regression models were used to estimate effect size as an odds ratio (OR) adjusted for sociodemographic and occupational variables. Contrasts for sex and occupation were made using Mann-Whitney U and Kruskall-Wallis tests on the dimensions of both models.

Results

EFA offered a solution containing 3 factors with eigenvalues > 1, explaining 73.22% of variance. CFA presented the following indices: χ² = 112.04 (p < 0.001), χ²/gl = 2.44, GFI = 0.958, AGFI = 0.929, RMSEA = 0.059, SRMR = 0.057, NFI = 0.958, NNFI = 0.963, IFI = 0.975, CFI = 0.974. The area under the ROC curve for 'overload' with respect to the 'exhaustion' was = 0.75 (95% CI = 0.71-0.79); it was = 0.80 (95% CI = 0.76-0.86) for 'lack of development' with respect to 'cynicism' and = 0.74 (95% CI = 0.70-0.78) for 'neglect' with respect to 'inefficacy'. The presence of 'overload' increased the likelihood of suffering from 'exhaustion' (OR = 5.25; 95% IC = 3.62-7.60); 'lack of development' increased the likelihood from 'cynicism' (OR = 6.77; 95% CI = 4.79-9.57); 'neglect' increased the likelihood from 'inefficacy' (OR = 5.21; 95% CI = 3.57-7.60). No differences were found with regard to sex, but there were differences depending on occupation.

Conclusions

Our results support the validity of the definition of burnout proposed in the BSCQ-12 through the brief differentiation of clinical subtypes.

An RCT of coping and support groups to reduce burnout among nurses

BACKGROUND

Burnout is a fundamental problem among nurses. Nurses need to be trained to reduce burnout.

AIM

The aim of this study was to evaluate the effects of coping and support group interventions to reduce burnout among nurses.

METHODS

A randomized controlled trial (RCT) was conducted at a University Hospital in Izmir, Turkey. Level of burnout was measured with Maslach Burnout Inventory before and after the intervention as well as in the following 6 months. A total of 108 nurses met the selection criteria and agreed to participate. To determine the effectiveness of the intervention, two-factor repeated-measures analysis of variance and paired t-test with Bonferroni correction were used when appropriate. All analyses were conducted on an intention-to-treat basis.

RESULTS

Right after the intervention, there was an immediate reduction in emotional exhaustion dimension of burnout with respect to time. However, in 6 months, scores were increased again. No significant difference was noted between groups and from the point of group × time interaction. There was not any change in depersonalization and personal accomplishment dimensions of burnout after the intervention.

CONCLUSION

By means of person-directed interventions, emotional exhaustion level can be decreased. The fact that burnout reduces after the intervention and an increase is observed in 6 months is an important result. Repetitive interventions can render the effect to be long lasting. It is recommended that the number of intervention studies to reduce burnout be increased and that long-term outcomes be observed.